IndiaFirst LIFE INSURANCE ABOUT INDIA FIRST At IndiaFirst Life, we come to work every day with the goal of making insurance easily available to every Indian household. From that momentous day in November 2009, when as the 22nd private sector entrant in the Life Insurance Industry, we sold our first policy; to as of 31 March 2020, where IndiaFirst Life ranks 12th in the private sector in Individual NB APE for FY 2020. We ended FY20 on a strong footing with INR 3,360 crore worth of total premiums collected and AUM of INR 14,723 crore We've had Bank of Baroda, Andhra Bank (now, Union Bank of India) and Legal & General as our founding partners. After journeying with us through our years of growth, Legal & General sold its stake in February 2019 to Carmel Point Investments India Private Limited, a body corporate incorporated under the laws of Mauritius and owned by private equity funds managed by Warburg Pincus LLC, New York, United States. In April 2020, Andhra Bank was amalgamated into The Union Bank of India. Our shareholding pattern as of today stands at: Our Parentage Bank of Baroda: B (0) Union Bank of India: Third largest public sector bank in ‘Fifth largest public sector bank in India with ~120 years of legacy in India post its merger with Andhra successful banking, spread over 21 Bank and Corporation Bank with countries combined legacy of 300+ years Carmel Points Investments India Pvt. Ltd.: 4 Carmel Point Investments India Private Limited Is incorporated by Carmel Point investment Ltd, a body corporate incorporated under the laws of Mauritius and owned by private equity funds managed by Warburg Pincus LLCOTE IndiaFirst —— | = ES LIFE INSURANCE mal ite ned TERIOR Business APE E Ranked 12%among 4 private ployer in New Business APE FneY20, | U2 een ‘Most Acimireble Brands 5 Minmcdo for 2019 ~ 20 by NDTV Profit FY 2020, wth 26% YOY Grown ae Securing Lives, the indus Creating Value [APE in ast 5 yoars and also 5 FY 2017 year APE CAGR of 20% o FY 2014 ——_growtnat ez S FY 2019, Eccame teh gest fue by Oreee eais w=" Inca APE of 681 coves (Sevan th on FY 2015 finong Pate Payers Break evn th rele po oF NR Fv2001 ‘Achieved INR 900 Gr FY 2010, Im 500 days of business Seas operations inthe rmerket To vew the Kt of wads wor by nda, cx on ths fk: ssw nde confabentslawantsatsaeengabeB23 IndiaFirst LIFE INSURANCE KEY POINTS ABOUT BANK OF BARODA “Happy to be India's International Bank” 1. Proud to serve over 131 Million Customers across 19 Countries N The bank was founded on 20 July 1908. The bank, along with 13 other major commercial banks of India, was nationalised on 19 July 1969, by the Government of India and has been designated as a profit-making public sector undertaking (PSU) w Branch Network (As on 28.02.2021) METRO 1801 URBAN 1482 SEMI-URBAN 2094 RURAL 2853 TOTAL BRANCHES (DOMESTIC) 8230 TOTAL OFFICE (DOMESTIC) 255 FOREIGN (OVERSEAS) BRANCHES/OFFICES 96 TOTAL (GLOBAL) 858 4. Operating profit increased by 9.39% to % 12,006 crore in FY 2018 against % 10,975 crore in FY 2017 led by growth in both the interest income and fee income. 5. Total domestic deposits during the year grew at a lower rate of 6.11% in the back drop of surplus liquidity with the BankOnag 2) 3) 4) 5) IndiaFirst LIFE INSURANCE KEY POINTS ABOUT UNION BANK “Good people to bank with” The Bank is a listed entity and the Government of India holds 89.07 percent in Bank's total share capital It has a network of 9500+ domestic branches, 13300+ ATMs, 11700+ BC Points, serving over 120 million customers with 75000+ employees The Bank also has 3 branches overseas at Hong Kong, Dubai International Financial Centre (UAE) & Sydney (Australia); 1 representative office in Abu Dhabi (UAE); 1 banking subsidiary at London (UK), 1 banking joint venture in Malaysia; 3 para- banking subsidiaries and 3 joint ventures (including 2 in life insurance business). Union Bank of India was established on 11th November 1919 with its headquarters in Mumbai. It was promoted by Seth Sitaram Poddar The Head Office building of the Bank in Mumbai was inaugurated by Mahatma Gandhi, the Father of the nation in the year 1921t a lower rate of 6.11% in the back drop of surplus liquidity with the Bank KEY POINTS ABOUT CARMEL POINT Warburg Pincus LLC manages the Carmel Point Investment Ltd., a body into existence since 1966 and has been incorporated as Carmel Point Investments India Private Limited for its operations and expansion in India. Authorised Capital = 9,50,00,00,300 Paid up capital % 8,66,16,55,600IndiaFirst LIFE INSURANCE 3-IN-1 PLAN TO BEGIN RIGHT IndiaFirst Life Mahajeevan Plus Plan (Non-Linked, Participating, Individual, Limited Pay, Money Back Endowment Life Insurance Plan) —___Ade 3itm aster IndiaFirst LIFE INSURANCE 7 REASONS YOUR MONEY IS SAFE WITH INDIA FIRST LIFE INSURANCE BANK OF BARODA : More than 120 years old bank along with 8000+ branches all over the world. ee UNION BANK OF INDIA : Andhra Bank and Corporation Bank have amalgamated into Union Bank of India with effect from 01.04.2020, with this, the Bank's total business as of 4st April 2020 stood at Rs.15,34,749 crore, comprising Rs. 868632 crore of deposits and Rs. 666117 crore of advances. CARMEL POINT INVESTMENTS INDIA PRIVATE LIMITED Warburg Pincus LLC manages the Carmel Point Investment Ltd., a body into existence since 1966, SECTION 54 - Investment of assets Notwithstanding anything contained in the Indian Companies Act, 1913 (7 of 1943), an insurance ‘company shall not be wound up voluntarily except for the purpose of effecting a amalgamation or a te-costruction of the company, or on the ground that by reason of its liabilities it can not ‘continue its business. SECTION 27- insurance act, 1938 Regulation of Investments (4) Life Business : Without prejudice to section 27 or Section 27A of the Act, - Every insurer carrying on the business of life insurance shall invest and at alll times keep invested his. controlled fund in the following manner. sina aunhe’s gon meplaso oe oye 5 ote tbs ged Eesti ers seed Roan 8 oodng 35 Section 64 - investment of assets According to Section 64VA of the Insurance Act 1938 there is a Solvency Margin of Rs. 150 crores that needs to be maintained by each and every insurance company. It needs to be submitted to the Reserve bank of India under the supervision of the Insurance Regulatory and Development Authority of india (IRDA), as safety deposit money which is kept for repayment to customers in case the company declares bankruptcy before paying out the claim. Also the Solvency Margin keeps increasing as and when the insurance company increases its portfolio. Thus, even if the insurer winds up its business and decides to move out of the country, RBI can repay the customers from the security deposit money that it keeps on behalf of the insurance company. Reinsurance Each insurance company is attached with a Re-Insurance company who takes up the liability of repayment to customers in case of a very large claim if the insurer is unable to payB23 IndiaFirst LIFE INSURANCE PROMOTERS OF INDIAFIRST BANK OF BARODA Aecounts Loans v Investments v Insurance ¥ Digital Products» _Otfers_Other Senioes IndiaFirst Maha Jeevan m ; Plan . (Beastie) gtity ata > es =» S £ @ = Death benetts Reguar premium Guaranteed maturtyTaxbenefis under Tax bones under * ‘cntritone ‘mount ‘secton 606 ‘Secon 10 (100) UNION BANK OF INDIA Sur lon Baie Lite surance Coss QT ©®6¢000001A IndiaFirst LIFE INSURANCE Glimpse of past 8 years journey between UAS INTERNATIONAL and India First Life Insurance PC Re Sr Raker Rea ee a el) Ms R.M.Vishakha (MD & CEO) of India First Life Insurance Received the Award in Mumbai Convention on 18th Dec 2016 from era VA KU kaso Re me Ma ay1A jon IndiaFirst —— = ES LIFE INSURANCE Glimpse of past 8 years journey between UAS INTERNATIONAL and India First Life Insurance \ Received the Award in Jaipur Convention on 2nd May 2016 from BeNOR en ie ‘AIM TRAINING CONDUCTED FOR NORTH INDIA TEAM HEADED BY RUSHABH GANDHI DEPUTY CEO INDIA FIRST LIFE INSURANCEIndiaFirst LIFE INSURANCE ‘st Life Insurance Company will continue to embrace the digital mindset of people, processes, and technology to seize the future.” - Rushabh Gandhi (Deputy CEO, India First Life Insurance Company Ltd) IndiaFirst Life Insurance Company has embraced a Life Insurance ‘Company brand experience to ‘each of its customers, Furthermore, to secure their life's certainties, we have established seamless accessibility ‘with Ghar Baithe Insur- ance during the lock- down phases in India. A strong marketing inte- gration with Netiix’s visibility on OTT - it wherein viewership has Deputy CEO, IndiaFirst LifeInsurance __-#rewn exponentially. Coney is TustChill digital cam- ; palgn fortified ourpres- mbracingadigtalmind- ence on Social Media set, wecontinuetofocus _ while ourin-house pod- on People (#Employ-_ cast*Financially Speak- eeFirst), Process ing’, continues to edu- (#CustomerFirst) & cate consumers throug Technology (#Tech- stimulating conversa- First) to seize the future. tions. In summary, we TToday, customers are continue to strengthen evolved and interested our brand presence by in engaging only on ing, a theirterms. IndiaFizst and improvisingte a ates IndiaFirst LIFE INSURANCE “We've come a long way from clocking Rs. 160cr in the whole FY15 to Rs. 160cr plus a month” - Vishakha (MD/CEO, India First Life Insurance Company Ltd ) IndiaFirst Life Insurance Company’s growth has been fuelled by its unique brand ous 12-year to“Talk Life, Not Death’ journey, Indi- through its uniquely aFirst Life has crossed __ positive proposition of many milestones. To- “Because Life Is Pull of day, it features among _Certainties’. From then the top 10 private life _till now, it has been a insurance players in In- conscious decision to dia. We've come a long build a narrative based way from clocking Rs. _on #certainties. India- 160 Cr in the whole of First Life's growth has FY15 to Rs, 160 Cr plus been largely fuelled by amonth! Ina crowded its unique brand-posi- and competitive eatego- tioning, which has won ry that thrives on hearts and accolades “fear of the unknown”, _ alike, culminating with IndiaFirst Life the prestigious ET Best Insurance Company Brands 2021 Award. oO nits illustri- Ltd tookarradical stanceUSPs — MAHAJEEVAN PLUS PLAN 2. GOVERNMENT PROMOTOR BANKS - BOB & UNION BANK INFLATION CONTROL INTEREST LIQUIDITY FROM (REVISIONARY BONUS) 13th MONTH GUARANTEED HIGH RETURNS. BRANCHES AVAILABLE WITH EVERY PINCODE. (AFTER SALES SERVICE) ASSIGNMENT FEATURE LAPSATION PERIOD FOR 1 YEAR LIFE COVER IS 10-11 TIMES MINIMUM PREMIUM = 30,000 + GST PREMIUM FREQUENCY MONTHLY) HALF & YEARLY (FROM YEAR 2) MARRIAGE WOMEN ACT ENTRY AGE = 3 YEARS BOB IS AVAILABLE IN (FOR 15 YEARS TERM), HOLIDAY PERIOD = ¢ YEARS 21 COUNTRIES, ENTRY AGE = 1 MONTH UNION BANK AVAILABLE IN (FOR 20 YEARS TERM) 2 COUNTRIESDOCS REQUIRED: PAN CARD/DL FOR AGE PROOF.: You have to courier the Documents to following mentioned addess: AADHAR CARD FOR ADDRESS PROOF: Meghna Chhabra Mobile No.: +91-8448594947 Email: meghna@uasinternational.in UAS International Goup of Companies PASSPORT SIZE PICTURE: CHEQUES SHOULD BE NAME PRINTED: BANK STATEMENT IN CASE WHERE NAME IS NOT PRINTED ON CHEQUE | Unit No~226, 1st Floor, Vipul Agora Mall, Sector -28, Near M.G Road Metro Station, NOMINEE DETAILS: Gurugram, Haryana - 122001 NAME: From Dos: Your name: Mobile number: NOMINEE SHOULD BE IN BLOOD RELATION ONLY: Address: CHEQUE SHOULD BE IN THE FAVOR OF INDIA FIRST LIFE INSURANCE COMPANY LIMITED STUDENT DETAI NAME: CAMPUS NAME: CONTACT NO.1: CONTACT NO.2: EMAILID: DOCUMENTS NEEDED FOR PROPOSER & LIFE ASSURED: [ADDRESS PROOF DOB PROOF HIGHEST BANK PROOF INCOME PROOF (ANY ONE) (ANY ONE) EDUCATION PROOF | (ANY ONE) (ONLY (BOTH PROPOSER & | (BOTH PROPOSER | (BOTH PROPOSER & | (ONLY PROPOSER) | PROPOSER) la) &LA) La) (Above 80,000) TLAADHAR CARD PAN CARD T SCHOOL/COLLEGE [7 PASSBOOK Tir ID CARD (ast 3 Years) ZPASSPORT [2 PASSPORT 2. GRAD. MARKSHEET |2. CANCELLED CHEQUE 3.PASSBOOK 13. BIRTH CERTIFICATE|3, POST GRAD. MARKSHEET. @:DRIVING LICENCE _[4. 10" MARKSHEET 5. VOTER 1D) IS. DRIVING LICENCE [6. LANDLINE/ELECTRICITY BILL ‘© 01 RECENT COLORED PHOTOGRAPHS OF PROPOSER & LIFE ASSURED EACH #01 LIVE PHOTO FROM MOBILE WITH CURRENT DATE NEWS PAPER OF PROPOSER & LIFE ASSURED Corporate Office : Unit No.-126, 1st Floor, Vipul Agora Mall, Sector - 28, Near M.G Road Metro Station, Gurugram, Haryana - 122001 Contact: 0124-4285911 + Email: info@uasintemational.n - Website: www.uasinternational.inL PREMIUM PAYER OPTIONS Ea The person is buying for himself/herself which means same person is the proposer and Life Assured. In this case that same person be paying from his/her own bank account, credit card/ Debit Card/NEFT/Cash S es For Ex: Rasleen buys the plan in her own name so she is the person who will pay for it too PAY SELF Pe Sa Oe In case the Proposer and Life Assured are different people, Proposer can be spouse/parents or Grand Parents of Life Assured Here, the premium has tobe paid by the Proposer fom his/her own bank eke account/ credit card/ Debit Card/NEFT/Cash, For Ex: Rasleen's mother buys the plan for Rasleen. Here Rasleen is the Life assured and her mother is the Proposer. So the premium has to be paid by the Proposer (Rasleen's mother) from her own bank account/ credit card/ Debit Card/NEFT/Cash UFE ASSURED PROPOSER RD In this case where Proposer and Life Assured is the same person but the first premium can be paid by spouse/parents or Grand Parents of Life Assured in love and affection. Here, the third party needs to share his/her PAN card and aadhar card as mandatory documents eke Please Note: a) Third party is only paying the first premium, rest all premiums will be paid by the person in whose name the plan is. b) Third party is not eligible to take benefit of any plan features and so is LIFE ASSURED not liable for any tax rebate ss ‘THIRD PARTY PROPOSER For Ex: Rasleen buys the plan in her own name (She is both proposer and Life Assured), but her mother wants to pay the first premium. Eee ST ee Oars So Se In this case, the first premium can be paid by spouse/parents or Grand Parents of Life Assured as a gift but future premiums will be paid by proposer only. Here, the third party needs to share his/her PAN card and aadhar card as mandatory documents. Please Note: a) Third party is only paying the first premium, rest all premiums will be UFE ASSURED PROPOSER paid by the person in whose name the plan is b) Third party is not the eligible to take benefit of any plan features and @ so is not liable for any tax rebate For Ex: Rasleen's mother buys the plan for Rasleen. Here Rasleen is the Life assured and her mother is the Proposer. But Rasleen’s father wants to pay the first premium, THIRD PARTYSTEPS TO PROCESS THE CASE 1- Submit all the mandatory documents as listed below * Incase of Self (Same Proposer and Life Assured) a) Aadhar Card ( front and Back) b) PAN card ¢) Live photo (head to toe picture) d) Cheque (in the name of India First Life Insurance Co. Ltd.) e) First page of passbook f) Last one month bank statement * Incase of different Proposer and Life Assured a) Aadhar Card ( front and Back) ~ both of Proposer and Life Assured b) PAN card - both of Proposer and Life Assured ¢) Live photo (head to toe picture)- both of Proposer and Life Assured The below bank related documents only of the Proposer: d) Cheque (in the name of India First Life Insurance Co. Ltd.) e) First page of passbook f) Last one month bank statement Note: In case of third party, the aadhar card and PAN card of third party will also be required. 2- Once the documents are submitted, Client will receive a 6-digit OTP on their Registered Mobile Number. © The client may receive a call from UAS International or India First for the same © The client will be required to provide it for the authentication 3+ After the OTP, client will receive the payment link on their Registered Mobile Number and E-mail ID. The client will be required to make the payment within an hour else the link will expire. 4- After this, the client will receive a verification call within 48-hours of sharing the OTP wherein he or she needs to verify the details. Important Note: In case, the client misses the verification call due to any reason, he/she will be required to call as per their convenience on the below given toll free number and verify: 180-267-8474PERSONAL DETAILS (KNOW YOUR CUSTOMER] PERSON INSURED NAME: Do. PLACE OF BIRTH: FATHER NAME: PAN NO, MOTHER NAME: E-MAIL: ‘SPOUSE NAME: CONTACT NO.1: CONTACT NO.2: MAILING ADD: AADHAR NO.: POLICY OWNER/APPOINTEE NAME : D.O. PLACE OF BIRTH FATHER NAME : PAN NO: MOTHER NAM E-MAIL: SPOUSE NAME: CONTACT NO.1: CONTACT NO.2: MAILING ADI AADHAR NO. PREMIUM AMOUNT :, PREMIUM MODE : BASIC SUM ASSURED RIDE! HEIGHT(FEET/CM) WEIGHT(KG) POLICY TERM : PREMIUM PAYING TERM OCCUPATION : (SERVICE/SELF-EMPLOYED/PROFESSIONAL) :. COMPANY NAME : NO. OF YEARS IN SERVICE/BUSINESS: DESIGNATION : ‘ANNUAL INCOME NATURE OF DUTIES : EDU. QUALIFICATIONS :, NOMINEE DETAILS: NAME : D.0.B. : FATHER NAME : CONTACT NO.1. CONTACT NO.2 MOTHER NAME PLACE OF BIRTH SPOUSE NAME: RELATUON TO LA: FAMILY DETAILS : FATHER NAME. AGE (Yrs) (ALIVE/NOT ALIVE) MOTHER NAME AGE (Yrs) (ALIVE/NOT ALIVE) BROTHER NAME AGE (Yrs) (ALIVE/NOT ALIVE) SISTER NAME AGE (Yrs) (ALIVE/NOT ALIVE) DAUGHTER AGE (Yrs) {ALIVE/NOT ALIVE) SON AGE (Yrs) (ALIVE/NOT ALIVE) HaBIT: SMOKIN (NO. OF CIGARETTE/DAY) DRINKING: (ML/WEEK) EXISTING INSURANCE DETAILS: IF ANY INSURANCE CO : ANNUAL PREMIUM : TOTAL LIFE INSURANCE COVER : NO. OF POLICIES: ‘ANY ILLNESS :* ‘Mandate Form - Direct Debit / NACH ‘The Geanch Manager, Bank Name Date Bank Branch NameG Address Ld Ret: Authorization o pay Inia fe Insurance premium throveh Dect Debit (OD)/ NACH Dear Sir/Madam, 1 We undersigned authorize Incas Life Ineurance Company Limited her authorized service provider odebt my /ourbank account trough NACH / Direct Debit towards Paymentofmy/ our lie nsurance premium as pe"the seta lprov desbelow Lo rect oe ‘Appieation No.7 Paley Ne, “Amount Cn worded “Amount | Frequency (a yeary/hall | Start Date] EndDate yearly Quartely/Menthly) Nam ofthe Account Hold nameottrenccoumveier | L | {LLL E EL LEELLLELLLLLELLLELLLLELLL accountol LLL LE LLLLELLELLLLL Accouttype [_]sevines Ceeerent ‘xing of your sropritay frm / company stamp is mandatory incase of curent account) mice code Apocaie incase ees paymend_L_L_L_LL_LLL isthe 9 dit code onthe cneque book issued bythe Dank Vou are requested to alah a cancelled cheque for verison ofthe MICR Code) IFSC Code Aol incase Non ES payment appearing onthe Cheaue bold LELLL wore LLLLLLLLL. nai) DDecarationforAutoDebit. ‘Yes,1/ wehaveattacheda blankcanclledcheque Certificate ofthe Bank Namedinthe ve transaction Is delayed or not eeced at al for reasons of incomplete or | Mandate Incorectinformation I/ weshallnetholdthecomaanyesponsibleforsuchdelay | iticertiled hat at per our records, the bankaccountpartcularsofthemandatesboveare ‘ornoncredttom policy. + In acdition, YWe understand and agree that the premium amount tobe debited rommy/ our acount may vary to axes ang ater stator vies semay be | BarkStam> Signatureot Authorized Borkoffil Sppicnle trom tm to tre, We leo acceat thatthe transaction Mil be tHectedtotnepoieyon the duecate(provdetiea working) + Incasoofan 5 erect debit honor V/ We authorie nist elnsurancetore- ‘ebtmyorbinkaccountwththementonedbanktorecovetheprersimpable, + Thereby authorize Inia ie Insurance Co Lt, and their autherie sevice providers to debit my Bank Account directly or by NACH fr collectionet Dremu peyients DD mandate shouldbe veri comectandthesignatueofthebarkaccounthoderistue by bank branch and shouldhave “Signature iEwith"fixedspecinen signetarenamber™” + /We hereby agree te maintain adequate bloncein the secount stated herein for ling Direct Debit fait. INACH/ DD is automsted facity which debits your premium from the bank account + Wa hereby authvize the Bank to debitmy acount towards charges forDD_ | Speciacby you on your premium due ate except nase ofa haliay ttandate verteation tf anyapplicabe L IL yi 1 jl Poleyholders Signature Primary Accountholders Signature JointAecountholdare Signature Joint Account holders 2 Sgnatare (paar Atoat Robe otf ran Peele) Indianist Tek (“4 Sponsor Bank Code uty code CREATE TndiaFirst Life Insurance Company Ltd. | ro debi (ek) [58/CA/6C/SO-NRE/S0-NRO /oter EREATE Nw hereby authorize P to debit ek”) LEANCEL] panka/enumber with Bans vise mic an amount of Rupees FREQUENCY CI Mthly Chay Bk-Yrly ively fas@when presented —Debittype C1 Fix ‘Maximum Amount sartenion ] obi Petey He. Emailio “altesacaed ttm sted e/a tr naaty apes tae omc on ter ny / ners eth ak wh he thd IndlaFist Life Insurance Company Ltd, 12th and sth Flor, North [CJ Wing, Tewer 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregeon (Eas0), Mumbai - 400068, CIN: Usso10MHZ008PL.C183678, E-mail: customer irsttindafistlfecom Website: wwwindafirstifecom ‘Tol #9122 6165 8700 Fax: 19122 6857 0600 Toll Free: 1800-209-8700te IndiaFirst LIFE INSURANCE Proposal No, ‘Name of he Prospeei/ Paleyholder: [Ms Sivaya Rasiog) ‘Nam of the Product TndlaF rt Le Mahajeavan Plus Pan ‘Age | 26 Teg ine ‘Nor-Linked Paricpating Money Back ‘Nano ofthe Life Assured | Ms Shraya Rasioal Insurance Pian ‘Age | 26 ‘Unique entfcation No asN0SeVTT Policy Term 15 For Base Polcy ial Year 45% pa remum Paying Term | 12 sr Rate 2nd Year onwards: 2.25% p.a “Amount of instalment Premium | €20,000 For Rider 18% pa. ‘Made of Payment of Premium | Yearly How to read and understand this beneft illustration? This benefit ilustration i intended to show year-wiee premiums payable and benefits under the policy, at wo assumed rates ofinterest i.e, 8% pa. and 4% pa, ‘Some benefis are quarantees and some benefits are varable with retums based on the future performance ofthe insurer carrying on fe insurance business. your policy offers guaranteed benef then thess wil be clearly marked guaranteed inthe ilustration table on this page. If your polity offers varable benefits then the lustrationson this pago wl show two different rats of assumed future invostmont returns, of 8% p.a ane 4% pa. Theso assumed rates of rotum ar not ‘uarantesd and they are not the upper or lower its of what you might get back, 35th value of your policy is dependent on a numberof factors including future investment performance Policy Details Plicy Option NA ‘Sum Assured Re 21800 ‘Sum Assured on Doath (atincopion of Bonus T ‘Simple Revisionary Bonus 300,000 ype " | the policy Re. igars Opted NA “Term Rider Sum Assured (Re) w WOP Rider Option Premium Summary Base Pian Rice “etal nstaliment Premium Tnstalment Premium without GST 0,000 w 0,000 Tnslalment Premium with Fist year 251,950 0 331,350 ost Tnslalment Promium with GST 2nd 7 7 year Onwards 230.675 © 350675 (Amounts in Rupees.)1, Pease const ou nsurance Corsa for any clafcations os his istration, 2 Annualized Premium excludes underwriting extra premium, quency loadings on premiums, the premiums pad toward the des, iany, and Goods and Services Ta. 4. Refer Sales Litre fr expantion of ms used in lastaton and more det on sk tr, exclusions and ote tems and conditions abou the product. 4. Premiums payable ate elpble or tax benefits under Seton 80 (C ofthe Income Tax Actas apoicable om me ttn) s ‘ 1 Allens payable under the Plicy ae subject wo the tx laws and cher iancilenactnent, x aplicale fa inet time. Surender Vale pyle provided ft two yes prem ave been pid fl Surender Valu, i any as pe the above able, shal be higher of Guranteed Surender Value and Special Surender Value The plan offers simple revrionary bos, which may vary rom ie ome, 9, The Investment Rates of Return stated above ae only indicative and dos ot in any way indicate the uppe iit or lower imo th Investment Rate of Return 10, Tee Carpany declares that it may cage extra prem subject to underiting of propo before the acceptance afk, 1. This benef illusratin has been generated basis my subi ssessment and on my confirmation the same has ben propose tome 12, Please note that Cash Bons is nt appliabe fortis produc spr te Product TRC. |, have explained the premiums, ard benefis under the product fulyto the | | | Ms Shreya Rastogi, having recived the information with respec othe prospect policyholder. ‘ove , have understood the above statement before entering into the contract Place ‘Signature of Agent Intermedia Date 2021-06-30 offeat Date : 2021-06-30 Signature of Prospect Polcyholder License Code: ‘Requost you to submit the folowing mandatory requ 1) Standed Age rool 2) Photo 3) Phot Identity Poot 48) Address Poot sents along with the application form:1 32917.5 32604 33858 33858 33858 2_| 30675 | 66772.125 | 65810.16 | 69695.64 0 69695.64 | 69695.64 3 | 30675 | 102319.4813 | 100344.5664|108400.2912| 30900 69470.64 | 75028.2912 4 | 30675 | 139644.2053 | 136260.3491| 150201.3145 0 105703.2912 | 114159.5545 5 30675 | 178835.1656| 173612.763 | 195346.4197, oO 144834.5545 | 156421.3189 6 | 30675 _|219985.6739 | 212459.2735 | 244103.1332 0 187096.3189 | 202064.0244 7_|_ 30675 _| 263193.7075 | 252859.6445 | 296760.3839| 30900 _[ 201839.0244 | 217986.1463 8 30675 | 308562.1429 | 294876.0303 | 353630.2146 oO 248661.1463 | 268554.038 9 30675 _| 356199.0001 | 338573.0715 | 415049.6318 oO 299229.038 | 323167.3611 10 | 30675 | 406217.7001 | 384017.9943 | 481382.6023 oO 353842.3611 | 382149.7499 11 | 30675 | 458737.3351 | 431280.7141|553022.2105| 30900 _[381924.7499| 412478.7299 12 | 30675 | 513882.9518 | 480433.9427 | 630392.9873 oO 443153.7299 | 478606.0283 13 539577.0994 | 499651.3004 | 680824.4263 oO 478606.0283 | 516894.5106 14 566555.9544 | 519637.3524 | 735290.3804 oO 516894.5106 | 558246.0715ya IndiaFirst LIFE INSURANCE ms Benefit Illustration Proposal No. : Name of the Prospect |) M15 ak Kalia Name of the Product IndiaFirst Life Mahajeevan How to read and understand this benefit illustration? This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a. Policyholder : [Plus Plan Age || 28 Non-Linked Participating Name of the Life Assured :| Ms Mehak Kalia Tag Line Money Back Insurance ‘Age | 28 Plan Policy Term] 15 Unique Identification No. : | 143N059V01 Premium Paying Term | 12 For Base Policy: 1st Year- 4.5% pa. ‘Amount of installment] Premium | €25:000 GST Rate : 2nd Year onwards- 2.25% pa. Mode of Payment of] vy For Rider:18% p.a Premium ‘Some benefits are guaranteed and some benefits are variable with returns based on the future performance of the insurer carrying on life insurance business. If your policy offers guaranteed benefits then these will be clearly marked ‘guaranteed’ in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will show two different rates of assumed future investment returns, of 8% p.a and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance. (Rs.) Policy Details Policy Option NA ‘Sum Assured Rs. 339,850 ‘Sum Assured on Death (at Bonus Type Simple Revisionary Bonus _| Sum Assured on Death (a 350,000 inception of the policy) Rs. Riders Opted NA Term Rider Sum Assured x WOP Rider Option GST 2nd year Onwards Premium Summary Base Plan Riders Total Installment Premium Instalment Premium without 235,000 20 35,000 GsT Instalment Premium with 236,575 20 336,575 First year GST Instalment Premium with £35,788 x0 35,788NonGumaneea | Nonumamece | Tot Bonottincnding Guararioos ard Nom acy | Se2lo! Berat@en na | Genet @ espa [Tay dene ‘eat Bnet Premium | Guarateef Survet | Surender] Oeath | aturty | Revsionar Surender Revisonar Suen] Netty | Naturty | eath | eat ‘saaon | saneit | eenett | senett | genet | Bonve | senett | Sonus | Senait | Benet Benots@ | Benet re ae | a 7 z z = z 7 z z oe a 7 7. 2 [38000 _| 0 [ae s0000 | 2 o_[ ooo | ras | are | 0 0000 | sets 7 [35000 | 0 [ss [ seas asn000 | 0 a 0000 | «00878 =e [38000 | 9 | ra0050_ | ss0000 | —o O_ [050 | “reas i008 | 0 e000 _|_a1787O Te z z | aanaso_[aer009 | 0 Cn 221000_[s9a607 Notes : 1. Please consult our ‘Insurance Consultant’ for any clarifications on this illustration, 2. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Services Tax. 3. Refer Sales Literature for explantion of terms used in illustration and more details on risk factors, exclusions and other terms and conditions about the product. 4, Premiums payable are eligible for tax benefits under Section 80 (C) of the Income Tax Act (as applicable from time to time) 5. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as applicable from time to time. 6, Surrender Value is payable provided first two year's premiums have been paid in full, 7. Surrender Value, if any as per the above table, shall be higher of Guaranteed Surrender Value and Special Surrender Value. 8. The plan offers simple reversionary bonus, which may vary from time to time. 9. The Investment Rates of Retum illustrated above are only indicative and does not in any way indicate the upper limit or lower limit of the Investment Rate of Return. 10. The Company declares that it may charge extra premium subject to underwriting of proposal before the acceptance of risk. 11. This benefit illustration has been generated basis my suitability assessment and on my confirmation the same has been proposed to me 12, Please note that Cash Bonus is not applicable for this product as per the Product T&C, |, have explained the premiums, and benefits under |, Ms Mehak Kalia , having received the information the product fully to the prospect policyholder. with respect to the above , have understood the above statement before entering into the contract. Place : Signature of Agent! Date : 2021-05-07 Intermediary! Official Date : 2021-05-07 Signature of Prospect License Code: Policyholder Request you to submit the following mandatory requirements along with the application form: 1) Standard Age Proof 2) Photo 3) Photo Identity Proof 4) Address ProofFund Value Fund value ROI after) with 8% AGE| Premium FD Lic 7 [Money back | Deduction Che ofMoney | Compund me Interest 1 | 36575 | 38403.75 38038 39501 0 39501 39501 2_| 35787.5 | 77900.8125 |_76778.52_| 1311.58 0 g1311.58 | 1311.58 3_| 35787.5 | 119372.7281| 117068.6608 | 126467,0064| 36050 1049.08 | 87533.0064 4 | 35787.5 | 162918.2395 | 158970.4072 | 175234.8669 o 123320.5064 | 133186.1469 5_ | 35787.5 | 208641.0265 | 202548.2235 | 227904.1563 0 168973.6469 | 182491.5387 6 7 8 9 35787.5 | 256649.9528 | 247869.1525 | 284786.9888 0 218279.0387 | 235741.3618 35787.5 | 307059.3255 | 295002.9186 | 346220.4479| 36050 _[235478.8618| 254317.1707 35787.5 | 359989,1667 | 344022.0353 | 412568,5837 oO 290104,6707 | 313313.0444 35787.5 | 415565.5001 | 395001.9167 | 484224.5704 o 349100.5444 | 377028.5879 10 | 35787.5 | 473920.6501 | 448020.9934 | 561613.036 0 412816.0879 | 445841.3749 11 | 35787.5 | 535193.5576 | 503160.8331 |645192.5789| 36050 [445578.8749| 481225.1849 12_| 35787.5 | 5995301105 | 560506.2664 | 735458.4852 o 517012,6849 | 558373.6997 13, 629506.616 | 582926.5171 | 794295.164 0 558373.6997 | 603043.5957 14 660981.9468 | 606243.5778 | 857838.7772 0 [603043.5957 | 651287.0834ya IndiaFirst LIFE INSURANCE ms Benefit Illustration Proposal No. : Name of the Prospect | 1 M15 ak Kalia Name of the Product IndiaFirst Life Mahajeevan How to read and understand this benefit illustration? This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a. Policyholder : [Plus Plan Age || 28 Non-Linked Participating Name of the Life Assured :| Ms Mehak Kalia Tag Line Money Back Insurance ‘Age | 28 Plan Policy Term] 15 Unique Identification No. : | 143N059V01 Premium Paying Term | 12 For Base Policy: 1st Year- 4.5% pa. ‘Amount of installment] Premium | ©7000 GST Rate : 2nd Year onwards- 2.25% pa. Mode of Payment of]. For Rider:18% p.a Premium ‘Some benefits are guaranteed and some benefits are variable with returns based on the future performance of the insurer carrying on life insurance business. If your policy offers guaranteed benefits then these will be clearly marked ‘guaranteed’ in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will show two different rates of assumed future investment returns, of 8% p.a and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance. (Rs.) Policy Details Policy Option NA ‘Sum Assured Rs. 700,000 ‘Sum Assured on Death (at Bonus Type Simple Revisionary Bonus | Sum Assured on Death (a 700,000 inception of the policy) Rs. Riders Opted NA Term Rider Sum Assured x WOP Rider Option GST 2nd year Onwards Premium Summary Base Plan Riders Total Installment Premium Instalment Premium without 270,000 20 70,000 GsT Instalment Premium with 273,150 20 273,150 First year GST Instalment Premium with eri s75 20 371,575NowGumneca } wovGumanaag TORT Boranading Carriood wo Nor esd Bane oncumeread | Non Guxartnd Garand Bena otey | Soe! e e Tsay Bee Death Bane Premium | Guarateof Suvi: | surender| osatm | aatuty | Revsionat Surender | Revsonar Surende: atsiy | oes | oeae ‘adton | sanott | enett | sonest | onett | sonus | sonett | sonus | sonore Borat @ | Bonet @ i z z z = = 7 z z oa 7 7 15 [79000 _| 7 [oe ro00n | 2 3 | ee [as e00 | 0 0 | ro0nn0 [77600 ee Ce Co O | toasea [era [ starr | 0 ‘| 7e0000| 770000 7 [1000 9 |e |r2an | 0000 | 2 o_ [rasa | raas00_[ 60635 | 0 a [00 ¢__[-aara00_[_ea2000 | —o o_[-aars00 | ain 0se00 | 0 ‘3 | eaz000 | aso 7 7 z | ssar00_ | eana0 | —o o_ | sse7e0_| 2esn0_|soes00 | 0 0 —_[-po00 [77750 Notes : 1. Please consult our ‘Insurance Consultant’ for any clarifications on this illustration, 2. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Services Tax. 3. Refer Sales Literature for explantion of terms used in illustration and more details on risk factors, exclusions and other terms and conditions about the product. 4, Premiums payable are eligible for tax benefits under Si 5. All benefits payable under the Policy are subj tion 80 (C) of the Income Tax Act (as applicable from time to time) ct to the tax laws and other financial enactments, as applicable from time to time. 6, Surrender Value is payable provided first two year’s premiums have been paid in full, 7. Surrender Value, if any as per the above table, shall be higher of Guaranteed Surrender Value and Special Surrender Value. 8, The plan offers simple reversionary bonus, which may vary from time to time. 9. The Investment Rates of Retum illustrated above are only indicative and does not in any way indicate the upper limit or lower limit of the Investment Rate of Return, 10. The Company declares that it may charge extra premium subject to underwriting of proposal before the acceptance of risk. 11, This benefit illustration has been generated basis my suitability assessment and on my confirmation the same has been proposed to me, 12, Please note that Cash Bonus is not applicable for this product as per the Product T&C. |, , have explained the premiums, and benefits under |, Ms Mehak Kalia , having received the information the product fully to the prospect policyholder. with respect to the above , have understood the above statement before entering into the contract. Place : Signature of Agent’ Date : 2021-05-07 Intermediary! Official Date : 2021-05-07 Signature of Prospect! License Code: Policyholder Request you to submit the following mandatory requirements along with the application form: 1) Standard Age Proof 2) Photo 3) Photo Identity Proof, 4) Address ProofFund Value Fund value ROI | a ater | with 8% AGE| Premium FD uc F Money back | Deduction @8% of Money ee Beek 1_| 73150 | 76807.5 76076 79002 0 79002 79002 2_| 71575 | 155801.625 | 153557.04 | 162623.16 0 162623.16 | 162623.16 3_| 71575 | 238745.4563 | 234137.3216| 252934.0128| 72100 | 162098.16 | 175066.0128 4 | 71575 | 325836.4791 | 317940.8145 | 350469,7338 0 246641.0128 | 266372,2938 5_|_ 71575 _| 417282.053 | 405096.447 | 455808.3125 oO 337947.2938 | 364983.0773 6 | 71575 | 513299.9057 | 495738.3049 | 569573.9775 0 436558,0773 | 471482.7235, 7 | 71575 | 614118.6509 | 590005.8371 | 692440.8957| 72100 _[.470957.7235| 508634.3414 8 | 71575 | 719978.3335 | 688044.0706 | 825137.1674 0 580209.3414 | 626626.0887 9 | 71575 | 831131.0002 | 790003.8334 | 968449.1408 0 698201.0887 | 754057.1758 to | 71575 | 947841.3002 | 896041.9868] 1123226.072 0 825632.1758 | 891682.7499 a1 |_71575_| 1070387.115 | 1006321.666| 1290385.158| 72100 _['891157.7499| 962450.3699 12 | 71575 | 1199060.221 | 1121012.533| 1470916.97 0 1034025.37 | 1116747.399 13 1259013.232 | 1165853.034 | 1588590.328 0 1116747.399 | 1206087.191 14 1321963.894 | 1212487.156 | 1715677.554 0 1206087. 191 | 1302574.167ya IndiaFirst LIFE INSURANCE ms Benefit Illustration Proposal No. : Name of the Prospect |) M15 ak Kalia Name of the Product IndiaFirst Life Mahajeevan How to read and understand this benefit illustration? This benefit illustration is intended to show year-wise premiums payable and benefits under the policy, at two assumed rates of interest i.e., 8% p.a. and 4% p.a. Policyholder : [Plus Plan Age || 28 Non-Linked Participating Name of the Life Assured :| Ms Mehak Kalia Tag Line Money Back Insurance ‘Age | 28 Plan Policy Term] 15 Unique Identification No. : | 143N059V01 Premium Paying Term | 12 For Base Policy: 1st Year- 4.5% pa. ‘Amount of installment] Premium :| €120:000 GST Rate: 2nd Year onwards- 2.25% pa. Mode of Payment of] vy For Rider:18% p.a Premium ‘Some benefits are guaranteed and some benefits are variable with returns based on the future performance of the insurer carrying on life insurance business. If your policy offers guaranteed benefits then these will be clearly marked ‘guaranteed’ in the illustration table on this page. If your policy offers variable benefits then the illustrations on this page will show two different rates of assumed future investment returns, of 8% p.a and 4% p.a. These assumed rates of return are not guaranteed and they are not the upper or lower limits of what you might get back, as the value of your policy is dependent on a number of factors including future investment performance. (Rs.) Policy Details Policy Option NA ‘Sum Assured Rs. 1,020,000 ‘Sum Assured on Death (at Bonus Type Simple Revisionary Bonus _| Sum Assured on Death (a 1,000,000 inception of the policy) Rs. Riders Opted NA Term Rider Sum Assured x WOP Rider Option GST 2nd year Onwards Premium Summary Base Plan Riders Total Installment Premium Instalment Premium without 100,000 20 100,000 GsT Instalment Premium with 104,500 20 104,500 First year GST Instalment Premium with 102.250 20 102,250see! —_— Sews@enoa | Sewk@ekrs (aman | oan aa Po | amused =a) Toa} ea) oa Promum | Guarateet Survie | surender| Osan | matuity | Revaiona] Surender | Revsionay Suende atsiy | oem | o2ae ‘radion | sonoit | enett | sanest | onen | sonus | sonett | aonus | Senet Bonar @ | Benet @ i z z = z 7 z z oa 7 7 15 [0000 | 0 ara | 1900000 | 0 o_[ roe | rars00| 168075 ‘3—[-tooso00 1702000 760000 0 | oa065| zara [1000000 | —o o_ [rosa | reso | ras ‘0 —[-toooo0n [1755000 Tz [om | [39000 [-raea000- | —o ‘3 | eao000 | ao0000—| 708880 ‘3 [-12s0000 [1540500 Notes : 1. Please consult our ‘Insurance Consultant’ for any clarifications on this illustration, 2. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods and Services Tax. 3. Refer Sales Literature for explantion of terms used in illustration and more details on risk factors, exclusions and other terms and conditions about the product 4, Premiums payable are eligible for tax benefits under Section 80 (C) of the Income Tax Act (as applicable from time to time) 5. All benefits payable under the Policy are subject to the tax laws and other financial enactments, as applicable from time to time. 6. Surrender Value is payable provided first two year's premiums have been paid in full 7. Surrender Value, if any as per the above table, shall be higher of Guaranteed Surrender Value and Special Surrender Value. 8. The plan offers simple reversionary bonus, which may vary from time to time. 9. The Investment Rates of Retum illustrated above are only indicative and does not in any way indicate the upper limit or lower limit of the Investment Rate of Return 10, The Company declares that it may charge extra premium suibject to underwriting of proposal before the acceptance of risk. 11, This benefit illustration has been generated basis my suitability assessment and on my confirmation the same has been proposed to me 12, Please note that Cash Bonus is not applicable for this product as per the Product T&C. |, , have explained the premiums, and benefits under |, Ms Mehak Kalia , having received the information the product fully to the prospect! policyholder. with respect to the above , have understood the above statement before entering into the contract. Place : Signature of Agent! Date : 2021-05-07 Intermediary/ Official Date : 2021-05-07 Signature of Prospect! License Code: Policyholder Request you to submit the following mandatory requirements along with the application form: 1) Standard Age Proof 2) Photo 3) Photo Identity Proof 4) Address ProofFund Value | Fund value : RO! eee with 8% AGE| Premium FD Lic os — |Meneyback | Deduction | Cota ofMoney | interest back 1 | 104500 | 109725 108680 112860 0 112860 112860 2 | 102250 | 222573.75 | 219367.2 | 232318.8 0 232318.8 | 232318.8 3_| 102250 | 341064,9375| 334481.888 | 361334.304 | 103000 | 2315688 | 250094304 4 | 102250 | 465480.6844 | 454201.1635 | 500671.0483| 0 352344.304 | 380531.8483 5 | 102250 |596117.2186 | 578709.2101| 651154.7322| 0 _| 482781.8483| 521404.3962 6 | 102250 | 733285.5795| 708197.5785|813677.1108| 0 623654.3962 | 673546.7479 7 | 102250 |877312.3585 | 842865.4816|989201.2796| 103000 [672796.7479| 726620.4877 8 | 102250 | 1028540.476 | 982920.1009 | 1178767.382 oO 828870.4877 | 895180,1267 @ | 102250 | 1187330 | 1128576.905|1383498.773| 0 997430.1267 | 107224.537 10 | 102250 | 1354059 | 1280059.981 | 1604608.674| 0 1179474.537| 1273832.5 a1 | 102250 | 1529124.45 | 1437602.38 | 1843407.368| 103000 [| 1273082.5 | 1374929.1 12 | 102250 | 1712943.173| 1601446.476 | 2101309.958| 0 1477179. | 1595353.428 13 1798590,331 | 1665504.335 | 2269414.754| 0. 1595353.428 | 1722981.702 14 1888519.848 | 1732124.508 | 2450967.935| 0 _[ 1722981.702| 1860820.238PROMOTED BY IndiaFirst LIFE INSURANCE Se | mobite Noe | [TTT TT 1 J [Resisentwo'l | [TT TT TET ETT TL joreenof TTT TTT TT TET TT Contact details mentioned above willbe updated in our record fr further communication, SellAttested Address and ID Proof of Poleyholder is mandatory document tobe encloses oes + Assignment will pot be permitted for pension policies and or plies which are under the Marcie Woman's property Act, 1874 + Asper CBDT guidelines, n case of individual assignment, itis mandatory forthe assignee te submit Foreign Account Tax Compliance Aet (FATCAY/ Common Reporting Stardard (C88) declaration form. + Incase of portal azignment, ably ofthe incure hal be limited to the amount secures by partial atsigoment and such policy owner shall not be enled to further {ssign or transfer he resiusl aunt payable uncer the same pole, + PEP -Polticaly Exposed Person are individuals who are or have been extrusted with arominent pubic uretions i; heads/ministers of central/state Govt, Senior politicians, selor govt jucela’ or miltary off cals senior executives of govt. companies, maortant peltcal party aftls, immediate family member o above Persons (would nelude spouse, parents sings, chiaren, spouses parents ors bings and close associates of PEP). + Apoliey thats partially assignee will require jon discharge o the assignar and assignee forthe policy loan, pata withdrawal, surrender, maturity, survival benefit ‘rary other benefits payable under poey condlions ang as per the terms ane conditions of ss gent + Incase of assignment to an incvidual the assignor shoul submit KY of te assignee Poot of source of funds ofthe assignee wil also have tobe submitted it assignees anunvelstes thay. + Thefull name, age, address and elatanship af the assignee must be stated where the assign isan inivdu + Theassignment of» policy shall atomatialy cancel any nomination made in the policy. + The Assign hereby absolutely assigns all the rights tile ang interest in the policy to the assignee and all oher moneys thereby secured and benefits attached ‘hereto ts the Ass ghee forte velue receives, * incaseot assignment in fvrf Financial nstaon/ank please atic stamp othe Fnac sttion/ Bank and coutesignedy he Authorized nat ory +The witness should bea major and competent to contract. + -Assignr wil not beable to execute ary policy ateration o processing without the consent ofthe Assignee Incase of enanges, No Objection is require for Servicing Transactions ‘om assignee + Ongnal policy documents mandatory Nameotassienee:[ ] | [TT TT TTT TTT TTirTirTrTiii ttt ii ttt iit ttt titi address:[ TTT TTT TTTTT TTT TT TTT Trt tt ttt ttt tt rt tt tt rt) mobiteno| | TT TT TT TT [Resientne: (TTT TTT TTT TT TT foticenel TT TTT TTT EET Tt Cc a Relationship with Assignee (Parent/ Chil Lender/Creitors/Guarantar ete) Assignee Type Chrividt [CFinancilnsttution/Bank/Trst ‘Are youa “Politically Exposed Person" (PEP) []Yes [_]No Confirmation on FATCA/ERS Form submited [Jes []No Below mentioned details are mandatory only ifthe absolite assignment has ben made to on inviua and not oa stitution Bonk pateotBith: TTT TTT] Gender: C]male female Nationality: Jincian JR Occupation: [] Salaried TiBusiness [J Student Professional CO otmers| Identity Poot: C]Passpert — C]Pancand C]Voteri> CE ]tvingiense 1] Others Address Proot|["]Passport_ [Ration Card ["]VoteriD [J OrivingLicense [[] Others IndlaFist Life insurance Company Ltd, ‘ath and 1th Fleer, North [C] Wing, Tower 4, Nesco IT Park Nesco Center, Western Express Highway, Goregaon (ast), Mumbai 400083, IRDA Regd No. 143 CIN: Uss010NH2008°1C183679, E-mailt customer firstindatstlfecom Website: wwwindlfistlfeccom ‘Tel +9122 6165 8700 Fax 9122 6857 0600 Toll Free: 800-209-8700 Application of Assignment Form/V2/Oet 2020,IndiaFirst LIFE INSURANCE B sasataot | Wendie tank Endorsement on the policy document signifying assi 1 Assignor have received sum of Rs upees Din consideration rom the assignee forthe assignment 1 Assignor have assigned the policy out of love and affection and have not received any consideration from the assignee. 1 Specity any other reason: we. thin named holder of policy issued by InioFrst Life Insurance Co.Ltd hereby assign and transter all iy fights tile and interest within the aforementioned policy number. | further affirm that such assigoment shal be subject othe concition that in the event of death during the term ofthe policy, the benelit as er the policyterms and conditions willbe pad tothe Assignee to the extend af he libiity under this asigrment, Any amountin excess after the above payment shall be pad to my nominee, | understand that submission of this request shallbe treated as adequate notice af assignment Ya the company. | have enclosed my origina policy document herewith forthe assignment tobe registered, ‘Notice of Assignment under Section 38 ofthe Insurance Act 1938 as amended irom time time +The assgnor assigns absoltly all the rights and interest inthe policy mentioned above ts the assignee. + The assignee names in the form willbe recognized a the person entitle to the benefits ofthe polly subject tothe terme anc conctions of aesignment Signature of Assgnor (poleyhelde) Signature of Assignee Place: pate TTT TTT] Pace pate EET TET) En ‘The assignor has executes the endorsement an the polity. The signature / thumb imoresson i of the assignor and assignee ane he/she has affixed iin my presence on the date stated above after fully understanding the contents thereof | hereby state tat | have explsined the contents ofthis form to the assgnor and assignee in language ane signee/afixe thumb impression in my presence (tobe mentioned the signatures in vernacular language/thurs impression) Signature of Witness Note The Decora dentiy shouldbe easly esablshed and e/she shouldnt e coaeetectinsier in any capa Name of witness: Relationship with Assignor& Assignee: Adsrezs of witness: Pace: pote EET ET TTT) Es [Name & Signatore of Branch Oficial with Stomp Pace Request Date Request Time Enclosure: Orginal policy document ny ‘2th and 13th Floor, North [C] Wing, Tower 4 Nesco IT Park Nesca Center, Western Express Highway, Goregnon (Fast), Mumbai ~ 400063, IROAI Rega. No. 143] CIN, UssO1OMHZ008PLC183679, Exmal-customerfirstsngiafistitcom Website: www.indafirstitecomtes sim aghes Bank of Baroda IndiaFirst LIFE INSURANCE LOAN APPLICATION FORM. Ca ' The poli shallbe assigned te India Fst Lite Insurance Company Ltd a secunty towards due repayment of the loan, together with interest, + Lean mill be provided oni ifthe last due premium is pad or no premium i outstanding + The company i allowed to charge interest tthe rate o& 5% Interest zal be calculate on simple interest basis onthe outstanding loan amount. +The loan amount shall be restricted othe term othe poiy wth an option ta the policyholder torepaytheloan amount together ith interest, costs, claims and expenses before the pay altains matur + Incase Surencer value at any time less than oan outstanding pos acrued interes, then pan terminates. + Claim proceeds willbe pad after deduction of outstanding loan amount including intrest, any til ate of claim intimation * Inthe event ofan application fo aO2nd loan under the Policy the outstanding loan and interes, if ny, onthe existing loa shall be deducted out of he total ava lable and balance only il be pal to te poieyhoer + Oniy the Patcyholeris entitled to apply for loan under the policy. The lan shallbe governed as per terms and conditions af the policy contract, + Poy shall be Actve/Inforce to availtheloan Original Paley dacumeatis mandotory + ‘Maches Bark account or00f (Copy of Bank tatemenl/Canceled cheque/Passbook + Selhattested Address and ID Proof of Plcyholder is mandatory cocument to be enclosed Een reo CODD ove: CEEELEET PaeyHlertone we] wis) Sol J) ECC mobieno: [| [TTT TT TTI Residento:[ | [TT | TT TTI otficeo: [TT TT TT TTT) ened: EEEEELEELELEEEE ro Contact details mentioned above wil be updated in our records for further communication Dear Si/Madam, 4 poleyholder ofthe above mentioned policy hereby agree to the terms anc conditions ‘mentioned inthe form and wish te apy for loan against this poly. Aeques yout rant an amount a mentioned below oe (Ameuntinword?) OR LD) asin sete amount pe pan etre aloblc tmnt te 0% ft rene ve Poe Ve, (liye ders name) hereby secign the above Policy to IndaFist Life Insurance Company Lc whose corporate office adéress is T2th and 13th Floar, North (C) Wing, Tower 4, Nesco IT Pak, Nesco Center, Western Express Highway, Govegacn (Eas), ‘Mums 400063 in lev of the Loan mount received trom Ind at Life Ces | the owner ofthe above mentioned policy issued by Indias Life, hereby assign tis policy subject othe terms anc conitions mentioned herein and thereby transfer the rights and benefit of the sad policy in favour of Indi Life be 1 EEEEETTT! Nome of AccountHoléer’ [TT EETTTTELTTTELI TLE) isccove CLOT = ‘Account Number: CLTITTITTTI TTT iT iti tty) oseccot: LETT TTT ITEE) ¢ sonknome’ CTT TTTTTTTTTIT ttt ttt) Brane Name EE | the policy holder/Asignor eo hereby declare that have read and understood the Terme anc Coneitions mentioned herein nd agree to abce by the same Tals hereby take the sole responabity for ary transaction elected By IndaFrstife incase of any incorrect bank scour dats mentioned by me hs form jaFirstife Insurance Company Lt, “oe00120 61658700 Fane Fre: 1800-20987 {2th ana 3th Floor, Noth [C] Win, Tower 4, NescoTPack Nezco Centr, | T# *9122.665 8700, Fexs¥912246887 0600 Toll Fre: 800-209-8700 Wester Express Highway, Goregeon Eas, Mumbsi - 400083, IROAL Regd No. 13 1 CIN: U6SOTOMHZOD8PLCTER67S. worn aiethte.com customer firstindiaistlie.com WsPROMOTED BY Qi? 380 ha | acs IndiaFirst LIFE INSURANCE Not: n order to abide by the Foreign Account Tox Compliance Act (FATCA), kindly submit an Insurance FATCA Declartin, separately ithe answer to ay of these cuestions is 2 es" (D Are you a citizen of any thes country apart ‘am India (dual or multiple citizenship) any ether country other than Inia; (i) Do you hale a green card of USA or any similar card for anyother county? i) Are ou a resident (or tax purposes) of be Hl Ll 1 Signature/Thumb Impression of Poicyhelder Pace Date |do hereby state that have ead out and explained the contents ofthe frm tothe policyholder in ‘that whatever | have stated herein aboves tre and correct tothe best of my knowledge and belt. The palcyholder has signed affixed the thumb impression ater uly understanding the contents thereof Name ofthe Declarant ‘Aadress ofthe Declarant language anc he/she have understood the same. | declare Signature Relation with the Policyholder. Contact No: hereby cert that the contents af the form have been clearly explained o me and have fully understonc them. futher cerity thatthe ancwers corde inthe form ave as per the information providee by me. bo Signature/Thumb impression Note The Decinran deny held easy established ncthe/ene shoe net be conecteta neuer in any cape Ene ira 1 Hl Ll [Name & Signature of Branch Offical with stamp Pace Request Date Request Tine IndiaFist Life Insurance Company Ltd, 1th and 3th Flor, North [C1 Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregeon (East), Mumbai - 400088, IRDA Regd No. 13 | CIN. U6O10NH2008P1.183679. Exmail:customeristaindlafistltecom Website: +9122 6165 8700 Fax: +9122.6857 0600 Tollfree: 800-209-8700 vrai.PRomoreD ay IndiaFirst LIFE INSURANCE roe: COOCLEPLEA owe: EEEEEEEE! recrrone wi MeL] wO | COCECC OEE EE) LTT Mobile No Ct ] Resort No T omen: ETT LLL 1I TTI I enw: EECEEEEEEELE EE Contact details mentioned above willbe upéated in our records for urther communication EINE adiress: [TT TTT TT TTT TTT TTT itt i itt ttt tr itt itt tt ttt tt ciysvitogel | TT TT TTT} sete [PT TT PT) Pincede | | | | | | | | Please nae: Self-Attested Address and IO Prot of Polcyholder is mandatory document to be enclosed such as Passport copy, Electric Bil, Ration Care, rng Licence, Bank statement needs tobe sumittecalong mits the request. (Any one) [D1 Policy Hotder [7] titeAssured [7] Nominee [7] Appointee atest ith: [DTD DT Please note Selt-Attested Address and ID Proof of Polieyholderis mandatory document tobe enclosed suchas Passport Copy ith Cerlfieate, Driving Licence, ‘School Cerificate nee tobe submitted aang with the request. (Any one) GLU [Ly proteyHolder [] ute Assured [7] Nominee [] Anpointee CLO) CELT TTT TTT TT rr rr rrr TT tt ttt) Please note Sel-Attested Address and ID Proof of Poicyhoder is mandatory document tobe enclosed such as such age Mariage Certfiate, Gazette Copy in case of change in name and PAN car, Passport copy, Driving Licence ete For minar correction (Any one) from: [] Yearly [Ly Hattyearty—— [] Monthy te: [| Year [| Hattyeaty— [] Monthy Please note: Change in premium frequency made is allowed at the time of policy / biling anniversary and the same shal be elective from next premium ‘due date For changing to monthly mace, £C5/DD Mandate ané 3 months advance payments mandatory. PE iterate | do hereby state that have reac out and explained the contents ofthe frm tothe policyholder in language andhe/she have understood the same. declave that whatever have stated herein above is true and correct to the best of my knowledge and belef The palicyholées has signed /tfixed the thud impression after fully understanding the contents therect Name a the Declarant Signatures Relation withthe Poiyholder Adsrezs ofthe Declarant. Contact No, SITs igned in a Vernacular language) | nereby certy that the contents ofthe frm have been clealy explained te me and I have fully understd them further cert thatthe answers recordedin the form are ae pe te information provided by me. mo se bx | | GEEETTTT) Signature/Thumb Impression of Policyholder Place Date Es Name & Signature of ranch Oficial with stamp Place Request Date Request tine “oz0z 0/zA/tuieg ranboy 924049 Indiairt Life Insurance Company Ud, ue a ree |2thand sth Floor North (C) Wing, Tower 4, Nesco|T Park, Neseo Center, | TS 1912251658700. Fex:*9122.6857 0600 | Tollfree: 1800-209-8700 ‘Wester Express Highway, Goregnon (Ea), Mambsi~A00083, Man need Ne batt Ont UsennoNMLODEPLCIEETD Exmaitcusomertistaindatilifecom _ Website: ew indlarstife com